Assessment Problems

(1) Psychological constructs are difficult to measureespecially those involving sexual behaviour

- Constraints on measurement because: (i) The legitimate right of the individual to keepmuch of their sexual fantasy/behaviour private

(ii) ethical considerations (i.e., studying the development of sexual fantasies in children)

(iii) Sexual activity occurs in private (i.e., fantasies) or semi-private (most sexual behaviour)

(2) Individuals present misinformation about their sexual activity if it is socially stigmatized

- some have suggested that paraphiles are particularlygood at lying because they live lives that necessitatehiding

(4) For many sexual paraphilias there are simply no sound measures for detecting their presence or absencee.g., sexual fantasies

(3) Even if they want to be honest, various laws makeit difficult to paraphiles to report lapses or re-lapsesinto parahiliac behaviour

Therapy Problems

- There have been few well designed studies that lookat the outcome of therapies for paraphiles

- E.g., because of numerous design flaws, available research is equivocal with regards to whether treatments cause long-term change in pedophiles

(1) Mental health professions disagree over what countsas an effective therapy

- Simply calling something a “therapy” doesn’t makeit therapeutic

- This raises a number of ethical and practical considerations related to the societal and personalcosts of ineffective and/or unnecessary therapy

(2) Another problem involved in the treatment of paraphilias concerns the question of whether sexualorientation can be modified

- Research suggest that sexual orientation (i.e., overall pattern of sexual attraction and arousal) cannot bemodified

- Assumption that deviant sexual behaviour is moreplastic than “normal” sexual behaviour

- This suggests that paraphiliac sexual behavioursare no more “curable” than heterosexuality

- a more attainable therapeutic goal might be todecreases the intensity of paraphiliac interests andteach skills aimed at decreasing the likelihood that the paraphile will act on his orientation

- Goal of therapy is not a “cure,” but rather, themaintenance of abstinence from acting on the interest

(3) Recently, there has been an emphasis on treatingadolescent sexual offenders because:

(i) Some data suggest that many sexual offendersbegin offending in early adolescence so understandingthe developmental origin of such behaviours mustbegin at this point

(ii) Intervening early decreases the harm sexual offenders do to others and to themselves

(iii) Intervening early may increase the chances forsuccessful therapeutic outcome. -Rationale: Before the behaviours have been engaged in repeatedly, they may modifiable

- Despite sound rationale, intervention in adolescence presents difficulties because of the adolescent’s status as a legal minor

- Treatment of paraphilias involves discussion of sex,measurements involving sex (e.g., penileplethysmography), and sexual behavioural therapy(e.g., maturbatory reconditioning)

- Some clinicians have faced legal and ethical chargesbecause others have construed the treatment of adolescent sex offenders to be objectionable or indicative of child abuse

- The question is: Does the past behaviour of adolescents’ justify extraordinary therapy?

(4) Another problem with treatment is that manyparaphiles are not motivated to seek out and followthrough with therapy

-Many paraphiles are referred to therapy becauseof some legal problems or ultimatums from familyor employers

(5) Therapy often takes place in forensic (i.e., prison, mental institution) context which complicatesthe therapeutic process

(i) Who is the therapist’s client? The legal systempaying the bills, or the sex offender?

(ii) It complicates issues of therapist/client confidentiality. Does the probation officer receive periodic progress reports?

(iii) It can define important limitations on therapy(i.e., ability of the paraphile to interact with others,when therapy ends)

(iv) it can create unwilling and unmotivated clients

(v) it can involve the therapist and the client having a legal relationship that takes precedence over a therapeutic relationship

(vi) the high cost of treatment failure makes therapymore difficult

- because no therapy is 100% effective, the best thatcan be achieved is a reduction in the rate of relapse

(vii) Paraphiles treated in a forensic setting havehigh incidences of comorbid problems (e.g.,Substance abuse, marital/social problems, anxiety, depression, personality disorders, anger controlproblems)

-These comorbid problems are related in direct ways to the paraphiliac behaviour and thus, necessitate treatement above and beyond treatment of the paraphilia itself.

Research Problems:

(i) Lawsuits charging malpractice on the part of theClinician/researchers treating paraphiles are increasingly common despite the fact that acceptable standards were followed

(ii) funding for this type of research is scarcewhich research impossible or effective research difficult

(iii) Social taboo associated with sex research

There are a number of reasons why research on paraphilias is slow to non-existant: